Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up.

摘要

PURPOSE: A prospective study to evaluate whether certain baseline characteristics can predict outcome in patients treated with disc prosthesis or multidisciplinary rehabilitation. METHODS: Secondary analysis of 154 patients with chronic low back pain (LBP) for at least 1?year and degenerative discs originally recruited for a randomized trial. Outcome measures were Oswestry Disability Index (ODI) dichotomized to < or ≥15 points improvement and whether subjects were working at 2-year follow-up. A multiple logistic regression analysis was used. RESULTS: In patients treated with disc prosthesis, long duration of LBP and high Fear-Avoidance Beliefs for work (FABQ-W) predicted worse ODI outcome [odds ratio (OR)?=?1.9, 95% confidence interval (CI) 1.2-3.2 and OR?=?1.7, CI 1.2-2.4 for every 5?years or 5 points]. Modic type I or II predicted better ODI outcome (OR?=?5.3, CI 1.1-25.3). In patients treated with rehabilitation, a high ODI, low emotional distress (HSCL-25), and no daily narcotics predicted better outcome for ODI (OR?=?2.5, CI 1.4-4.5 for every 5 ODI points, OR?=?2.1, CI 1.1-5.1 for every 0.5 HSCL points and OR?=?23.6, CI 2.1-266.8 for no daily narcotics). Low FABQ-W and working at baseline predicted working at 2-year follow-up after both treatments (OR?=?1.3, CI 1.0-1.5 for every 5 points and OR?=?4.1, CI 1.2-13.2, respectively). CONCLUSIONS: Shorter duration of LBP, Modic type I or II changes and low FABQ-W were the best predictors of success after treatment with disc prosthesis, while high ODI, low distress and not using narcotics daily predicted better outcome of rehabilitation. Low FABQ-W and working predicted working at follow-up.